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Hyperkalemia = EKG… EKG changes = Calcium…

Step 1: Recheck the Potassium

  • Most common cause of hyperkalemia is PSEUDOhyperkalemia
    • Caused by too aggressive/fast of a blood draw
      • Causes RBCs to break open and falsely increase serum potassium

Step 2: Get an EKG

  • Earliest EKG change
    • Peaked T waves
  • Late EKG changes
    • Flattened P wave
    • Prolonged QRS
  • Critical/Emergent EKG changes
    • Sine wave

Step 3: Protect the Heart

  • EKG Changes = Give Calcium
    • Calcium gluconate (can be given IV)
    • Stabilizes the myocardium against dysrhythmia

Step 4: Shift Potassium Into Cells

  • Insulin (plus D50)
  • Albuterol

Step 5: Remove Potassium from Body

  • Kayexalate
    • Notorious for causing intestinal necrosis
    • Falling out of favor
  • Furosemide

Additional Reading